Nassar, 54, was sentenced in a Charlotte, Michigan, courtroom on three counts of criminal sexual conduct in the first degree, adding to long prison terms he already faces for additional sex crimes.

“I am not convinced that you truly understand that what you did was wrong and the devastating impact that you have had on the victims, their families and friends,” Judge Janice Cunningham told Nassar in court before handing down the punishment. “Clearly you are in denial. You don’t get it. And I do not believe that there is a likelihood that you could be reformed.”

Nassar read a statement in court before he was sentenced.

“The words expressed by everyone that has spoken, including the parents, have impacted me to my inner-most core,” he said. “With that being said, I understand and acknowledge that it pales in comparison to the pain and trauma and emotions that you all feel. It’s impossible to convey the depth and breadth of how sorry I am to each and everyone involved.”

“The breadth of the defendant’s abuse and destruction is nearly infinite,” the prosecutor said. ”... Few sports were saved from his predatory behavior, over a dozen different sports brought athletes to him who he abused.”

Povilaitis also applauded the bravery of survivors who spoke against Nassar.

“We are taught to trust. We have to trust ... We are, above all, taught to trust doctors, especially those who appear to be world-class doctors,” she said. “I truly believe we’ve seen the worst humanity in the last few weeks and we’ve also seen the best.”

The sentencing comes after more than 60 survivors delivered powerful victim impact statements in court to Nassar.

Former gymnast Tiffany Dutton said during the sentence hearing that she came forward with her story because of the “courage and bravery” of the other women who have already accused Nassar.

“It takes a monster to sexually assault a child,” she said. “But it takes a monster backed by ego, experience and power ― fueled by multiple institutions ― to sexually assault a child in front of their own mother.”

Among Nassar’s victims are Olympic gymnasts Aly Raisman, Gabby Douglas, McKayla Maroney and Simone Biles. According to court documents, Nassar served as team doctor for USA Gymnastics, various MSU sports teams and at a local Michigan gym called Twistars. As such, he gained the trust of girls and their families, which gave him cover for exams during which he fondled and digitally penetrated the girls.

The hearing became violent on Friday morning when Randall Margraves, a father of three girls who were abused by Nassar, attacked the disgraced doctor in court.

“I would ask you to, as part of the sentencing, to grant me five minutes in a locked room with this demon. Would you do that? Would you give me one minute?” Margraves asked Cunningham before he lunged at Nassar.

Several officers escorted Margraves out of the courtroom in handcuffs, but Cunningham did not hold Margrave in contempt of court. The father later apologized, telling the judge: “I lost control and I apologize a hundred times... I’m not here to upstage my daughters, I’m here to help them heal.”

Rebecca Cook / Reuters
Randall Margraves (L) tried to attack Nassar in court on Feb. 2, 2018. All three of his daughters were sexually abused by Nassar under the guise of medical treatment.

In January, Nassar sat through a weeklong sentencing hearing where 169 survivors and family members read impact statements. Raisman, along with fellow Olympians Maroney and Jordyn Wieber, read statements.

“Larry, you do realize now that we ― this group of women you so heartlessly abused over such a long period of time ― are now a force and you are nothing,” Raisman said. “The tables have turned, Larry. We are here and we are not going anywhere.”

Although Nassar will spend the rest of his life behind bars, many are wondering if the institutions that employed him for so long will be held accountable. Dozens of survivors have called for an investigation into USA Gymnastics, the U.S. Olympic Committee and MSU.

“I knew that he abused me. I reported it,” said survivor Amanda Thomashow in her statement during the earlier sentencing hearing. “Michigan State University had the audacity to tell me I did not understand the difference between sexual assault and a medical procedure.”

Several officials at USA Gymnastics, MSU and the U.S. Olympic Committee have resigned in the face of harsh criticism. MSU President Lou Anna K. Simon resigned last week. The entire USA Gymnastics board resigned, and former Olympic coach John Geddert retired. The NCAA has also opened an investigation into how MSU handled the case.

At the end of January, Congress passed a bill that aims to protect young athletes and regulate governing bodies of amateur athletics.

“[This bill] goes across all amateur sports, not just gymnastics, not just swimming ― it’s all amateur sports to protect all kids,” Nassar survivor and former gymnast Jeanette Antolin said at a news conference about the bill. “Because all kids should be able to go and do sports without having to worry about adult predators.”